We’ve all known someone who has battled weight and have seen many remedies and medical advancements in modern medicine but it’s still relatively new and evolving with so much science and new information. Dr. Shauna Costinett of GBMC joins Nestor to discuss obesity, bariatric surgery and life with The Shot and how the GLP-1 shots we all see advertised really work on your body.

Nestor Aparicio discusses obesity, bariatric surgery, and lifestyle changes with Dr. Shauna Costinett from GBMC. Dr. Costinett emphasizes the prevalence of obesity as a chronic disease and the importance of nutrition, exercise, and medication in treatment. She explains that GLP-1 medications, which have been used for over 20 years, can help with weight loss by slowing digestion and reducing food cravings. Surgery is an option for those with a BMI over 35 or 40, depending on comorbidities. Dr. Costinett highlights the need for small, sustainable changes in diet and lifestyle to achieve long-term health benefits.

• [ ] @Nestor Aparicio – Host the Maryland Crab Cake Tour event in Catonsville at The Fishmonger’s Daughter next week and provide Maryland Lottery scratch-offs and Maryland treasures as giveaways.
• [ ] @Nestor Aparicio – Serve broiled (not fried) crab cakes for the Maryland Crab Cake Tour moving forward.

Introduction and Segment Overview

• Nestor Aparicio introduces the segment, mentioning upcoming events and sponsors, including GBMC and Farnham and Dermer.
• Nestor discusses his personal health journey, including his participation in the 11th annual walk a mile in their shoes event.
• Dr. Shauna Costinett joins the conversation, sharing her experience of walking a mile in their shoes with her daughter.
• Nestor humorously recounts his childhood nicknames and his ongoing battle with weight and health.

Discussion on Obesity and Lifestyle Changes

• Nestor shares his personal experience with weight loss, mentioning his wife’s influence and his own dietary changes.
• Dr. Costinett emphasizes the prevalence of obesity as a chronic disease and the importance of lifestyle changes, medication, and surgery in treatment.
• Nestor discusses the societal pressure and personal motivation behind his weight loss journey.
• Dr. Costinett highlights the health risks associated with obesity, such as high blood pressure, diabetes, and heart disease.

Nutrition and Dietary Recommendations

• Nestor and Dr. Costinett discuss the importance of nutrition in weight loss, including the role of protein and low carbohydrate diets.
• Dr. Costinett advises on making small, sustainable changes to diet and lifestyle to achieve long-term health benefits.
• Nestor shares his personal strategies for maintaining a healthy diet, including drinking water and avoiding certain foods.
• Dr. Costinett explains the benefits of high protein, low carbohydrate diets in stabilizing blood sugar levels and minimizing cravings.

Role of Medication and Surgery in Weight Loss

• Nestor and Dr. Costinett discuss the role of GLP-1 medications and their effectiveness in weight loss and managing food cravings.
• Dr. Costinett explains the mechanism of GLP-1 medications in slowing digestion and affecting the brain’s reward centers.
• Nestor shares his observations on the changes in diet and lifestyle after starting GLP-1 medications.
• Dr. Costinett clarifies the long-term use of GLP-1 medications and the potential for weight regain if discontinued.

Assessing Candidacy for Weight Loss Treatments

• Nestor and Dr. Costinett discuss the criteria for determining candidacy for weight loss medications and surgery.
• Dr. Costinett explains the BMI thresholds for medication and surgery eligibility, including the presence of comorbidities.
• Nestor emphasizes the importance of seeking professional advice and support for weight loss.
• Dr. Costinett outlines the initial consultation process, focusing on patient goals and comfort levels with various treatment options.

Success Stories and Patient Experiences

• Nestor and Dr. Costinett discuss the success stories of patients who have undergone weight loss treatments.
• Dr. Costinett highlights the long-term benefits of weight loss treatments, including improved health and quality of life.
• Nestor shares his appreciation for the positive impact of weight loss treatments on patients’ happiness and well-being.
• Dr. Costinett encourages patients to seek professional help and support in their weight loss journey.

Conclusion and Final Thoughts

• Nestor thanks Dr. Costinett for her insights and encourages listeners to seek professional advice for weight loss.
• Dr. Costinett emphasizes the importance of having a primary care doctor for routine health maintenance.
• Nestor shares his personal health updates and ongoing efforts to maintain a healthy lifestyle.
• The segment concludes with a reminder of upcoming events and sponsors, including the Maryland crab cake tour and GBMC’s support.

SUMMARY KEYWORDS

Obesity, bariatric surgery, lifestyle changes, nutrition, GLP-1 medications, chronic disease, weight loss, high blood pressure, diabetes, metabolic panel, exercise, portion control, health maintenance, GBMC, comprehensive obesity management program.

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SPEAKERS

Dr. Shauna Costinett, Speaker 1, Nestor Aparicio

Nestor Aparicio  00:01

Welcome home. We are W, N, S, T. Am 1570 Towson, Baltimore. We are Baltimore positive. Get the Maryland crab cake tour back out on the road. We will be in Catonsville. It’s been too long. We’ll be at the fishmonger’s daughter. It is our first time there. They gave me my own table overlooking Frederick road. We will have the scratch offs in the Maryland lottery. I’ll have the Maryland treasures to give away. We’re not ready for Miss Pac Man yet. That’s so June. While we’re in May, before I get down to the beach, I will at least give away the boardwalk. Treasure also brought to my friends at GBMC. I am wearing my 11th annual walk a mile in their shoes, shirt. This happened last month. It will happen again. Next year, you can support our friends at GBMC in the safe and domestic violence and child protection program. We had a great conversation last week about that. We’ve we’ve talked about all sorts of things here with our GBMC friends. Also want to promote our friends at Farnham and Dermer, the comfort guys keeping me comfortable as well. We were at Planet Fitness and Timonium last week. Zach Dermer came on all of our sponsors to put us together and out on the road so we can have proper crab cakes and proper education, which we’re going to have in this segment here with our friends at GBMC. Dr Shawna castanet joins us here from over at the main campus at GBMC, right off the south. Chapman, did you walk a mile in their shoes? You liked my shirt?

Dr. Shauna Costinett  01:19

Did I love your shirt? I did walk a mile in their shoes with my daughter, Katie, who’s five years old, and attended the event as well. It was great event,

Nestor Aparicio  01:26

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man, you know, I don’t tell anybody, but I took some of the marshmallow treats that afternoon, and I would highly advise your five year old daughter to take the marshmallow treats next year too. She

Dr. Shauna Costinett  01:36

absolutely did.

Nestor Aparicio  01:38

Um, you know, I’ve talked about obesity in the past, and there’s two lanes. First thing I know, you look at me and say, Hey, man, he goes to Planet Fitness. He’s hitting the hot yoga. He even had a real checkup last week with Dr sanosi. I took I gave blood. Turns out, I need to go to Planet Fitness a little more often because I need to make some lifestyle changes. Says so right on my, my, my chart. I got it last week that I got, you know, anyone see this cluster? All that I got to take care of, better care of myself and watch the fried foods, is what I got, right? I know, you know, and Christina’s tuning in from GBMC, she might not know this. So people, my audience, might not know this. But in seventh grade, I had two nicknames at holliberg Junior High. Then one was meatball and the other was Doughboy, Pillsbury Doughboy, but that was only on weekends. You know, I was, I was like a little bit of an oval team. As a young person, I found wrestling and getting in shape and eating better, still trying to eat better. I’m still, you know, on that track at 57 at this point, but I’ve had a lot of friends in my life that portion control lifestyle eating a whole lot. I could show you the pictures as the Rio ravens game comes out that my wife and I took pictures in 2006 in Rio. We went to see the stones. I weighed 181 pounds. I weigh 148 pounds now losing weight, and that battle is something that begat me in 1979 1980 that all of my life, and a lot of my family members have had a battle with weight, and I think that that brings people to to you. Dr costanet,

Dr. Shauna Costinett  03:26

yeah, definitely. I mean, obesity is very prevalent worldwide, and especially in the United States, it is a chronic disease. It is something people struggle with their entire lives. And there’s a lot of different ways we can help combat the chronic disease of obesity, medication, surgery, lifestyle changes, all part of the tools in our toolbox that help treat the disease of obesity.

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Nestor Aparicio  03:50

First thing I did back in oh six, when I came back from Rio and I didn’t like my pictures and my wife didn’t like her pictures, was diet, and she was really into the television show that actually plan a fitness sponsor for a long time, the biggest loser and the Celebrity Fit Club shows, I saw celebrities go on and all of them, and I’ve talked about this freely, especially when I bring my planet fitness people on to talk about getting in shape, and sort of first move is all right, I need to eat less. I need to drink more water. I need to get started better with my metabolism earlier in the day. And every one of those weight loss shows began with oatmeal and like fresh blueberries and nuts and things like that in the morning. And just really making strides to change your diet, no matter what your methodology would be, what you’re putting into your system is that the first place you start when someone comes to you with an obesity issue? Doc,

Dr. Shauna Costinett  04:46

absolutely, nutrition is a huge part of this, and that is definitely the first place that we start with people when it comes to weight loss, number one, we want to focus on why it’s important for people. And while, of course, we want to look good in pictures. And feel good in our bodies. It’s all about our health and minimizing those chronic diseases that are associated with the disease of obesity, things like high blood pressure, diabetes, heart attack, strokes, cancer, risk, all of those things go up as our weight and our BMI starts to tick up. And by losing weight, we’re minimizing those risks of chronic disease, improving our health, improving our longevity, meaning we live longer in our bodies, which is, of course, what we all want. And nutrition is how we fuel our bodies. So while, of course, it’s pleasurable and enjoyable to eat, we want to be thinking about how we’re putting fuel in our bodies so that we’re fueling ourselves to live longer, healthier lives. And so what we typically recommend is high protein, low carbohydrate diet, usually we recommend about 70 to 100 grams of protein per day. Focusing on protein within two hours of waking up in the morning can really help jumpstart your metabolism and stabilize your blood sugar levels and minimize your cravings throughout the day. So that’s always the first place we start. The other thing I always tell my patients is slow and steady and small, sustainable changes over time. So when you’re focusing on making changes in your diet, you don’t want to be thinking about cutting out absolutely everything that you think is not healthy, but making one small change for a set amount of time, building it into a lifestyle habit, and then make another small change, so that over time, you build in healthy habits that you can work into your daily life, and you don’t feel like you’re depriving yourself from the things that you enjoy in your life.

Nestor Aparicio  06:29

Yeah, I, you know, I try to do it with the yoga mat, and that keeps me where I need to. I drink a lot of water because I have to when I’m sweating. And also, just, I was in New York the other day, and I knew I was hitting the yoga mat, and I looked at that cheeseburger, and I wanted it. I mean, I still want it right now. I didn’t have it. And, you know, now that I’ve had my blood drawn by my friends at GBMC this month, and I was convinced that I’m the healthiest 57 year old there could possibly be. You know, I do think about, well, snacking a little bit with my coffee, eating a little bit of knick knack, of this, and a little bit of that. And I don’t think too much about a french fry here, some pizza there, but, um, but I also have a scale, and I’m also aware, because I I’ve already admitted, you, I’ve admitted on my own radio show, they called me meatball and Doughboy when I was a kid. And I guess that’s part of the Dundalk shaming of, I don’t want to be fat. I don’t want to be this. But then also, like, the part where you give blood, and they’re like, Hey, you’re at risk, and the pre diabetes word starts coming up, and my wife’s been diabetic for 40 years, and my wife’s like, Dude, you’re watching me give shots. You don’t want to be that guy. And I think when people find a doctor like you, I don’t think a lot of super healthy people are seeking you out for bariatric surgery, or they come to you in distress in some way and various levels of I’ve battled this my whole life, or just over the last 10 years, I’ve put on 10 pounds a year every year, or five pounds a year every year, which doesn’t sound like much. Once you get to be my age, putting on two, three pounds a year every year, you look up and all of a sudden, I’m in your office, and I’m eating more than I should, and I can’t stop it. And it really it’s a disease. It’s not something that anybody I’ve ever known has been very easily able to control and then the surgeries came. And I think Tony Sarah goosa, the late Tony Syracuse, my friend, had lap band surgery 25 years I ran into goose. I’m like, What happened to the other half of you? And I didn’t know anything about any of that. And now I have lots of friends of mine that have become svelter, and they just say to me, I got the shot. That’s what they and I don’t even and I see the commercials, and I’m inundated with all of that. That’s why I love having you on Dr Costa net to sort of clear me up on what, what is modern about this. Because there was no shot before, and there was no I got the lap band thing there was, Hey, man, I’m getting in the old days, it was the holiday spa and the Bally’s. Now we go to Planet Fitness. But I don’t think there’s any way to do this, even when they’ve got a doctor got the shot or got any of these things without portion control, better diet and regular exercise and water. These are just basic things that my mom and dad probably died not knowing that stuff, this basic nutrition and movement.

Dr. Shauna Costinett  09:27

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Yeah, so let’s start with you’re talking about, you know, gaining weight over time. That is pretty much what the average American does, is gain weight every single year and start to struggle with their weight as they age, especially. And there is a lot of shame and stigma around that, and it can be really hard for people to come to their doctors, their physicians, whomever, and say, Hey, I need help with this. But it is really common, and there is no shame or stigma and asking for help with something that’s related to your health, people don’t feel shame or stigma when they say, Hey, I have high blood pressure. I need a blood pressure medication. Don’t feel a lot of shame or stigma if you need. Cholesterol or diabetes medications, struggling with the chronic disease of obesity, there should be no shame or stigma for asking your doctor for help, coming to see me or anybody in our comp program to ask for help with these issues. And we always start with that nutrition piece, but then, yeah, definitely the shots, the oral medications, the GLP ones that are very trendy right now are a huge part. They’re a tool in our toolbox that help us treat the chronic disease of obesity. Same thing with surgeries can be a great tool for people to help combat the disease of obesity. When it comes to the GLP one, medications, the shots, there is a misconception that these are like very new kind of medications. They have been used in the diabetes world for a long time now. I think the first one was approved in 2005 so over 20 years ago that people have been taking GLP one medications, and generally speaking, they’re very safe. Of course, there can be side effects or issues, but they have been like a big change and shift in trying to treat the disease of obesity when used, not just in the diabetes world, but in the chronic disease of obesity world, and they can be a great tool to help people gain some control over that nutrition piece and try to help work on food cravings and weight loss and improve their comorbidities, decrease their risks of long term health complications.

Nestor Aparicio  11:19

Dr Shawna castanet is a bariatric surgeon at GBMC, and they’re our healthcare partners. You can find them over on Charles Street, find them anywhere out on the internet@gbmc.org, so someone’s listening, someone’s watching, someone loves, someone that’s getting heavier and worried about it, or they gave blood like I did two weeks ago, and got a little smack on the wrist about their diet, about their lifestyle, but I think by the time people come to you, they’ve realized they’re past the point where they feel like they can control it on their own, or they found Planet Fitness on their own, or they found a workout buddy, or went out on the internet. And when they’re in your office and they come to you, where do you begin to assess who’s a shot candidate, who’s the lap bank like or how you can help individual people? And I know I’m being very broad here, because you see lots of different people every day, but I’m trying to encourage folks to if they’re feeling any of these things that it’s it’s not too late to pick up the phone and you can help them. And that’s why you’re there.

Dr. Shauna Costinett  12:26

That’s absolutely why we’re here. We’re happy to do it. So for medications, they are FDA approved. For anybody with a BMI or body mass index above 30, your BMI, you can go on Google, calculate that it’s just a ratio of your height to your weight. So if that number is above 30, you would potentially be a candidate for a medication. If it’s above 27 then you have what we call a qualifying medical comorbidity, something like high blood pressure, high cholesterol, sleep apnea, diabetes, then you might also be a candidate for medications, for surgery. Those numbers start a little bit higher. If your BMI is above 40, you’re a candidate for surgery. And if your BMI is above 35 and you have one of those comorbidities, you would be potentially a candidate for surgery as well. When people are coming to me in the office to talk about working on weight loss and health, I start by asking them, What is your goal? What are we trying to achieve? And what is your comfort level with the various options, diet, exercise, medication, surgery, they’re all part of those tools in our toolbox. And a lot of people, when they are coming to me, have an idea of what they’re looking for. A lot of people say, hey, I want to start a shot. I’m interested in a medication. Talk to me about that great. Let’s have that conversation. Some people say, I don’t want to be on a medication. I’m interested in surgery. Talk to me about that wonderful. Let’s talk about that. And some people just want to hear from somebody with some medical training, what can they do, from a diet and exercise standpoint to help improve their health? And they’re not ready to do medications or shots. They just want to work on that exercise and nutrition piece. So my first move is say, Hey, how can I help you? Tell me what you’re looking for, and let me guide you through these various options. And a lot of people right now are interested in the medications or the shots, and they’ve been a great tool for people. So if they’re interested, we talk about what that looks like. A lot of them are injections that you do once a week. There are some oral medications as well. So we talk about comfortability of patients with injections versus oral medications. We talk about side effects of these. GLP, one medications, a lot of gastrointestinal side effects like nausea, vomiting and constipation are really common. We talk about contra indication

Speaker 1  14:28

and

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Nestor Aparicio  14:28

that that I just for people I know that have had shots, and when I’ve been out at dinner, lunch, dining, and I you know, they’ve they offer, they’ve clearly lost some weight. The diet part comes up, especially on my crab cake tour, when I’m dining with people about the changes that happen when they’re in that process that foods you can or can’t eat, there’s a lot of sort of chemical changes that happen your body, of what you can tolerate, what you can’t tolerate, correct,

Dr. Shauna Costinett  14:59

correct. Yeah. So. The GLP one medications, they work by slowing down your digestion, so slowing down how your stomach empties, slowing down how things move through your bowels, which is why some people can get a lot of that nausea and vomiting and some constipation issues. They also work in what we call like the reward centers of your brain, or the pleasure centers, and that helps quiet that food noise, you’re not thinking about craving food, you have a little bit easier time making those healthy choices and choosing foods that are going to fuel your body and not going for something that you’re craving really strongly. So there’s some chemical changes that happen in your in your brain as well as in your gut that help decrease the amount of food that you want to eat or that you physically can eat, and that’s how they help with weight loss for people, and so for a lot of people, that does help them make those healthy food choices and minimize eating the things that we probably should be eating less of to begin with, I

Nestor Aparicio  15:51

want to talk to my veterinarian, because my cat just wants to eat 24 hours a day, and I’m thinking, There’s got to be some psychological thing, you know, she doesn’t really want To eat that much, and she’s skinny, but, but if she gives blood, maybe she’ll have some lifestyle change. Have to cut down on fried chicken and fried foods. Dr Shawna costanet is here. She’s with GBMC. So you know, it’s this bariatric surgeon, when I look you up and I’m thinking, how often does that become a thing at this point where someone comes in and you’re like, All right, we can, we can cut down on food, we can work on exercise, then the shot. But surgery is a last resort, right? I mean, this is something you’re

Dr. Shauna Costinett  16:30

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trying to actually, that’s kind of a misconception when surgery, surgery has actually been around longer than the GLP one medications. It’s also more effective than the GLP one medications, when it comes to numbers for how much weight people lose on average, and for the GLP one medications, they work really well for the vast majority of people when they’re on the medications, but for most people, if they try to come off medications, a lot of people are going to struggle with weight regain when they do that. So when I talk to people about going on GLP one, medications, I always warn people you might be considering this as a lifelong medication, which a lot of people will feel some stigma about. There’s no stigma around that people take high blood pressure medications for their whole life and don’t have a second thought about it. It helps improve their health and it helps keep them healthy, and that’s great. But for the GLP ones, a lot of our data does show that if you’re taking it to combat the chronic disease of obesity, if you try to come off of the medication, you’re going to struggle again with obesity and struggle with some weight regain. And so a lot of people don’t like to hear that and are interested in a surgical option, which is another tool in our toolbox. A lot more people qualify for surgery than people think again. It starts at a BMI of 35 depending on your medical issues, or a BMI of 40 if you have no medical issues. And it’s a big change. It’s a permanent change in your body. It’s general anesthesia. It can be a really scary thing to do, but it’s also kind of a one time thing. And then you focus on those nutrition, you take some vitamins, and a lot of people have really great success with significant weight loss that is really easy to maintain lifelong

Nestor Aparicio  18:08

Well, I guess being a doctor who does this for a living, on the other end of this, you must have a lot of successes and a lot of stories. On the other end of people that you’ve made their life happier, right? I mean, that’s people come to you very unhappy, right? It’s, it’s unhappy. I mean, I often see larger people, even in airports, each is thinking that’s, that’s a lot to carry around. And I’ve rarely met anyone that’s made that move, who doesn’t find themselves just it’s easier to get through the world, and it leads to a happier life, right? And I think you see those patients probably every day, and think, Hey, I’ve made a significant difference in people who were unhappy to being happier.

Dr. Shauna Costinett  18:50

Absolute Best part of the job, seeing our patient success stories coming back to see us years later, who are doing amazing. Their health is improved. They can get around and play with kids, grandkids, nieces, nephews, they feel good in their bodies. It is still a lifelong struggle, no matter which route that we choose to help combat that. But again, that nutrition person exercising on a regular basis, and then come see us if you need some help, we’re always here to help and get people through that journey.

Nestor Aparicio  19:17

Big appreciation all our partners at the GBMC healthcare. You can find them@gbmc.org Shauna Costa net is a doctor of bariatric surgery and general surgery, and the Medical Director of the GBMC comprehensive obesity management program. Yes, I’m reading that, because it’s a lot to say, Doc, thanks for coming on and educate. Did I leave anything out? You know, first things first, do what I did, make an appointment and come see the professionals. So if you’re having a weight problem, at least you’re getting the right kind of advice, right?

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Dr. Shauna Costinett  19:47

Yeah, absolutely. And shout out Dr Sanusi. She’s also my primary care doctor and my husband’s primary care doctor. She’s great. We love her. We have great primary care doctors at GBMC. So always a good place to start. Everyone should have a primary care doctor. So. One to go to for their routine health maintenance. And then if you need that extra help or support, come see us at comp, comprehensive obesity management program. We’re here to help too.

Nestor Aparicio  20:08

Hold on. I’m logging in with my face ID right now. There’s my my chart. See I got it all going on right now. Updated, comprehensive metabolic panel. Good morning. Unhealthy fat slightly Elevate, okay, I’m working on I’m working on myself. Okay, just to make sure that this is the only visit I’m gonna have with you, because I have, I’ve got my health together so much that we did the show at Planet Fitness last week, and my wife has begun mornings there. I think she still got a little bit of that lactic acid thing going on from her first workouts with April in May, over at Planet Fitness, we next week will be this is going to involve some eating, and I guess my crab cakes are going to be broiled, not fried, moving forward into the summer, which

Dr. Shauna Costinett  20:56

all about those small changes. Come

Nestor Aparicio  20:57

on, Doc, don’t do this to me. Right now the Maryland crab cake tour is going to be Catonsville next week, we’re going to be at the fishmonger’s daughter. I’m not getting any more fried foods. I’m cutting fried out, but the pizza I’m going to have to work on when I get the pizza. John fishmonger’s daughter, next Thursday, we will have scratch offs in the Maryland lottery. Our friends at GBMC also supporting us. And Farnon and Dermer. They are the comfort guys keeping a square with our HVAC and plumbing needs. They are at 410, 367777, I am Nestor. We are W, N, S T. Am 1570, Towson, Baltimore, and we never stop talking Baltimore positive, especially as summer is coming in, the bikini seasons right around the corner for guys like me. You.